Heart on the Hill - February 2014

February 2014

Tobacco Control Movement Marks 50 Years On January 11, 1964, the groundbreaking findings released in the first Surgeon General Report on tobacco caused Americans to radically rethink their perceptions on smoking.

Fifty years later, American Heart Association President Dr. Mariell Jessup joined six leading public health groups at an event to commemorate the anniversary of this life-saving report and to call for bold action to end the tobacco epidemic once and for all. During the event, Jessup discussed the association’s long-standing commitment to protecting Americans from the dangers of smoking, and highlighted the work that remains in the fight against tobacco.

A new report, released by current Acting Surgeon General Boris Lushniak, M.D., M.P.H. in mid-January, examined the health consequences of smoking and the progress achieved in the five decades since the 1964 report. More than 20 million Americans have died from tobacco-related causes since the first report was issued; of this number, about 7.8 million – or nearly 40 percent – died from cardiovascular and metabolic diseases. It is estimated that 5.6 million of young Americans alive today will die from smoking, unless we take action now to prevent it. In response to the report’s warning, American Heart Association CEO Nancy Brown said, “We hope the new Surgeon General’s report will finally prompt the few remaining skeptics to join the vast majority of Americans in the fight to make our nation 100 percent tobacco-free.” Photo: American Heart Association President Dr. Mariell Jessup

On December 26, President Obama signed into law the Bipartisan Budget and Emergency Deficit Control Act of 2013. While this deal may not be the grand bargain we had hoped for, it is the first bipartisan agreement reached on any aspect of the budget in some time. The act also contained a number of provisions we supported.

The Deficit Control Act replaced about half the cuts from the sequester, leading the way fora $1.1 trillion omnibus spending bill that was signed by the president on January 17. The more than 1,500 page bill provided FY 2014 funding levels for all 12 appropriations bills and also included a number of provisions related to the federal advocacy agenda.

Key among them was $1 billion increase for NIH, which, according to the Appropriations Committees, restored 60 percent of the sequester cuts made last spring. In a press statement, association President Mariell Jessup, M.D. said it was disappointing that the legislation did not fully restore the NIH sequester cuts. She added, “We strongly urge Congress to stop placing promising research at risk and increase federal support for the NIH.”

However, we were encouraged that President Obama in his State of the Union Address, said“Federally-funded research helped lead to the ideas and inventions behind Google and smartphones. That’s why Congress should undo the damage done by last year’s cuts to basic research so we can unleash the next great American discovery – whether it’s vaccines that stay ahead of drug-resistant bacteria, or paper-thin material that’s stronger than steel.”

See our budget summary for more information on how the Bipartisan Budget and Emergency Control Act and the Consolidated Appropriations Act of 2014 impact our federal heart and stroke priorities.

Nine advocates from eight states gathered in Washington, D.C. January 27-28 to lobby their congressional members on the “Fitness Integrated with Teaching (FIT) Kids Act.” This popular, bipartisan physical education bill was reintroduced on May 23, 2013 by Senator Tom Harkin (D-Iowa) and Representatives Ron Kind (D-Wis.) and Aaron Schock (R-Ill.). FIT Kids currently has 29 cosponsors in the House.

The advocates included physical education teachers, school administrators, researchers and parents. The group braved sub-zero temperatures in D.C. on their way to Capitol Hill the same day as the President’s State of the Union address, which served as good timing to remind policymakers about the importance of investing in a child’s health and academic achievement through quality, evidenced-based physical education. In addition, an ad co-branded with NFL Play 60 promoting the legislation ran in Politico, a Capitol Hill publication.

Even before the advocates arrived in our nation’s capital, they were busy promoting the FIT Kids Act on social media. Many of their stories were transformed into baseball cards which were shared via the You’re the Cure Facebook page and the advocacy Twitter feed. In addition, two advocates penned emails to a sizable portion of the You’re the Cure network, urging them to take action. These volunteers will continue their work in their home states, by sending thank you letters to members’ offices and contacting local papers.

The association will continue to strongly advocate for quality physical education programs. Be sure to watch your email for action alerts asking Congress to support FIT Kids.

After two long years of negotiation, the House of Representatives and the Senate finally came to an agreement on a farm bill. President Obama signed the bill into law on February 7, 2014. The law contained some provisions that the association supported and some that we opposed.

On the plus side, the bill contains provisions designed to increase healthy food consumption, including the authorization of the Healthy Food Financing program, which establishes grocery stores in food deserts, providing access to healthier food and often boosting local economies. The bill also provided full-funding for SNAP-Ed, a program that helps low-income Americans make healthy choices on a limited budget and expanded the program to include physical activity.

Unfortunately, the Supplemental Nutrition Assistance Program (SNAP) – which supports nutrition and food access to the most vulnerable Americans – was cut by $8.6 billion. The association was also disappointed with language that alters the Fresh Fruit and Vegetable Program by creating a pilot program that expands eligibility beyond fresh produce to canned, frozen, and dried fruits and vegetables. This unique, popular, and effective program provides the poorest children in our county with access to fresh fruits and vegetables – an opportunity they might not otherwise have. This program has been shown to increase overall consumption of fruit and vegetables for its participants and the association believes it should stay fresh-only.

We will closely monitor the implementation of the law and continue our efforts to support opportunities for all Americans to eat healthy.

In early November, the Food and Drug Administration announced a tentative determination that partially hydrogenated oils are not “generally recognized as safe,” which began the process to eliminate trans fats from our food supply. Under the agency’s proposal, food manufacturers would have to remove PHOs from their food products unless they receive premarket approval from the FDA.

There are significant health effects associated with consumption of trans fat, including an increased risk of developing cardiovascular disease. According to the FDA’s announcement, eliminating PHOs from the food supply could prevent 10,000 to 20,000 coronary events and 3,000 to 7,000 deaths each year, and save between $117 and $242 billion over 20 years. In a press statement following the announcement, association CEO Nancy Brown said, “We commend the FDA for responding to the numerous concerns and evidence submitted over the years about the dangers of this industrially produced ingredient.”

In upcoming comments to the FDA, the association will offer strong support for the agency’s proposal and recommend that the FDA require food manufacturers to remove PHOs from their products within 12 to 18 months of the FDA finalizing its decision. Individuals may submit their own letter to the agency by visiting the You’re the Cure website.

Last fall, the “Strong Start for America’s Children Act” was introduced in both the House and the Senate. The bill responds to President Obama’s call for universal early education, which he made for the first time in his 2013 State of the Union speech, and addressed again during the 2014 State of the Union.

The American Heart Association advocated extensively to include nutrition and physical activity standards in the legislation. We are pleased that nearly all of our recommendations were part of the final bill language, such as: pre-kindergarten programs incorporating nutrition services which align with the most recent Child and Adult Care Food Program guidelines; evidenced-based physical activity programs, with the suggestion to use the Institute of Medicine’s guidelines; the integration of community-based learning resources, including public parks and recreation; professional development opportunities for childhood nutrition and physical education programs; performance measures and targets to help track high-quality nutrition services, nutrition education, physical activity, and obesity prevention programs; and technical assistance to help providers of Child Care and Development Block Grants to implement nutrition, physical activity, or obesity prevention programs.

As Congress moves forward on these pieces of legislation, the association will closely monitor and continue to advocate for policies that give children a healthy start in life.

After getting off to a rocky start, the number of Americans enrolling for health insurance coverage through the Marketplace has been increasing exponentially each month.

According to the Department of Health and Human Services by the end of 2013:

·Nearly 2.2 million people have selected private insurance coverage through both state and federal-run marketplaces, through December 28.

·In the federal Marketplace, the number of people who selected a plan increased 7-fold in the month of December alone, with more than 1 million people enrolling in coverage during December.

·Of the nearly 2.2 million, 54 percent are female and 46 percent are male, and 30 percent are age 34 and under.

·Fourth-fifths of those who have selected a plan are receiving financial assistance to help make their premiums affordable.

Although federal rulemaking to implement the coverage provisions of the Affordable Care Act is coming to an end, there have been a few recent actions of interest to the association:

·On January 14, HHS announced that people currently still enrolled in the federally-run Pre-Existing Condition Insurance Plan (PCIP) will be able to keep that coverage through March 31, to allow them more time to enroll for health insurance coverage through the Marketplaces.

·On January 21, we submitted comments on the Quality Rating System for health insurance plans participating in the federal and state insurance marketplaces.

The association continues to help educate those Americans in need of health insurance about new coverage choices, as well as provide staff and volunteers with the information and tools they need to assist in our outreach efforts. Since the last Heart on the Hill, the association sponsored its second TeleTown Hall call about the health care law, this one aimed at the Go Red For Women audience. More than 22,000 volunteers from across the country participated in the call to learn more about how the law impacts them.

After years of temporary fixes, Congress has been actively working on legislation that would permanently replace the Sustainable Growth Rate (SGR), an outdated formula used by Medicare to pay physicians for the services they deliver.

The legislation currently under discussion permanently repeals the SGR and replaces it with a new model designed to move away from traditional fee-for-service, and reward physicians based on the quality of care that they provide. On July 31, 2013, the House Energy and Commerce Committee unanimously passed legislation, and on December 12, 2013 the House Ways and Means Committee, as well as the Senate Finance Committee, passed similar legislation.

For more than a decade, the American Heart Association has dedicated significant efforts and resources to quality improvement on behalf of the nation’s heart and stroke patients. As a result, the association’s staff and volunteers have provided technical assistance to congressional staff as discussions continue to unfold. We continue to believe that any legislation must incorporate a number of elements in order to produce successful outcomes, including: the development of and adherence to clinical practice guidelines and measures; the use of clinical data registries; robust data linkage; hands-on support/technical assistance; and seamless coordination across the care continuum. The association continues to advocate that these are not only the critical elements of quality improvement; they are also the necessary components for an equitable value driven payment model. It is imperative, however, that Congress doesn’t lose site of the overall goal for a reformed system – one that is based on tested and proven models, supportive of the best clinical evidence, and truly patient-centered.

The association is also closely following provisions in the bill that:

·Provide quality measure development funding to entities that we hope will include the association;

In late November, the Centers for Medicare and Medicaid Services (CMS) announced its intention to expand Medicare coverage of cardiac rehab services to patients with chronic heart failure. This coverage decision could extend access to cardiac rehabilitation to millions of Medicare beneficiaries. This action was taken in response to a request made by the association, the American Association of Cardiovascular and Pulmonary Rehabilitation, the American College of Cardiology, and the Heart Failure Society of America. In a joint letter to CMS, the four groups expressed concern that Medicare did not currently cover cardiac rehab for chronic heart failure patients, despite evidence that cardiac rehab confers significant clinical benefits to these patients, including increased exercise capacity, reduced mortality, and enhanced quality of life.

President Mariell Jessup, M.D. applauded CMS for taking the action on behalf “of the 5.1 million Americans who suffer from chronic heart failure.” She added, “Allowing a majority of these patients to obtain cardiac rehabilitation services under Medicare will substantially improve their outcomes and help them achieve a better quality of life.”

CMS is currently in the process of finalizing its decision which is expected to be released in mid-February.

In late October, American Heart Association volunteers met with the staff of three congressional committees, as well as staff at the U.S. Department of Health and Human Services, to discuss our ongoing work in quality improvement, and to preview a related paper released in the journal Circulation.

The Circulationarticle, “Synthesizing Lessons Learned From Get With The Guidelines®,” illustrated how this program has helped hospitals deliver better care for a broad range of cardiovascular conditions. The data revealed how hospitals consistently following Get With The Guidelines® measures can reduce patients’ length of stay and 30-day readmission rates, decrease disparity gaps in care, and subsequently may lower health care costs. The release of the Circulation article was timely as Congress is actively engaged in drafting legislation that would replace the current Sustainable Growth Rate formula with a system that pays Medicare providers based on quality.

During our meetings with congressional staff, Dr. Gary Ellrodt and Dr. Lee Schwamm previewed the successes with our suite of inpatient quality programs, Get With The Guidelines®. In addition, Dr. Mary Ann Bauman discussed our ongoing partnership with the American Cancer Society and the American Diabetes Association in developing The Guideline Advantage®, our quality improvement program that uses electronic health records data to help ambulatory practices adhere to prevention and treatment guidelines.

Through the various discussions, we were able to clearly illustrate the value of our work and the impact we have had on patient outcomes. We are also hopeful that this will continue to position us as a resource to Congress and the administration on quality improvement.

Congress has passed a temporary extension through March 31 of the Medicare therapy caps exceptions process, while it continues to work to find a permanent solution to these limits. The association is very encouraged that the Senate Finance Committee’s SGR reform bill, which passed in December, would permanently repeal the caps and replace them with a new prior authorization process for paying for outpatient therapy services that would begin January 1, 2015. The Department of Health and Human Services (HHS) appears to have a great deal of discretion to limit prior authorization to outlier users/providers of therapy services, so we believe this will be an improvement over the current arbitrary caps on outpatient therapy services. The House Ways and Means Committee is also working on legislation that we hope will include a permanent repeal of the therapy caps.

The association advocates for repeal of these caps so that stroke beneficiaries can have access to the outpatient therapy services they need.

Illinois and Missouri Require Newborn CCHD ScreeningIllinois and Missouri proudly join the growing list of nearly 30 states that screen all newborns for critical congenital heart defects (CCHD) using a pulse oximetry test. In Illinois, the association's staff, volunteers, partner organizations and parent advocates took part in a Special State Governmental Committee tasked with designing a pulse oximetry screening protocol. The coalition then worked with legislators and regulators to draft a bill that was later signed by the governor.

In Missouri, the association's staff resumed an effort that began in 2012 by educating lawmakers and recruiting key partners. Kelly Manz and her daughter Chloe, who was born with multiple congenital heart defects, gave a powerful testimony that helped recruit bill sponsors and influential supporters of the legislation. The bill passed unanimously in the Senate, by a clear majority in the House, and was then signed into law by the governor.

Medicaid Beneficiaries Achieve Tobacco Cessation CoverageThe state of Vermont recently announced that it will provide comprehensive tobacco cessation coverage for Medicaid beneficiaries. Vermont already covered medication therapy for tobacco cessation, but the decision to cover in-person counseling resulted from a multi-year effort by the association, coalition partners, and the state department of health. Although the effort was threatened by proposed cuts to the state's tobacco control program, volunteers convinced legislators about the importance of the program and secured the additional funding.

Maine also recently passed a bill providing strong, comprehensive cessation benefits in the state's Medicaid program. Association staff, volunteers and coalition partners worked together to educate legislators about the bill. As a result of this effort, they ultimately approved funding but the governor vetoed the bill; advocacy staff and volunteers ultimately convinced the legislature to override the veto and the bill became law.

Chicago Raises Cigarette Tax and Restricts Flavored TobaccoThe Chicago City Council recently voted 45-5 to approve a 2014 budget that will raise the Chicago cigarette tax by 50 cents per pack. This comes on the heels of consecutive $1.00 state and county increases over the last two years, bringing the total to $7.17 - the highest in the nation. The City Council also passed a proposal to restrict the sale of flavored tobacco products, including menthol-flavored cigarettes, within 500 feet of a school. This ordinance aims to protect kids from the marketing practices of tobacco companies. With Chicago's population at 2.7 million, these recent developments on the tobacco front have the potential to save many lives.

Utah Designates Stroke Facilities
Stroke patients in Utah will now receive the life-saving services they need from hospitals that meet the American Heart/Stroke Association's standards, and national accreditation standards. These new facility designations have potential to provide higher quality care and save more lives across the state. This win comes after years of collaborating with the Utah Department of Health, the Utah Hospital Association and many others.

Transportation Bill Has Big Implications for Physical Activity in PennsylvaniaThe Pennsylvania legislature recently approved a bill establishing a fund that will provide an annual appropriation of $144 million to support multi-modal projects on a competitive basis. Walking and bicycling initiatives (including Safe Routes to School) are eligible to apply for support through this fund. Additionally, the state appropriated $2 million for walking and bicycling initiatives and established a bicycle and pedestrian coordinator who will oversee these projects.

Chicago Public Schools Make Strong Commitment to Physical EducationRecently, the Chicago Board of Education voted unanimously to adopt a new policy that recognizes physical education as a core subject and requires it daily in the city's public schools. The policy, which will be implemented across the district over the course of the next three years, is a critical step in our collective efforts to develop physically literate individuals who have the knowledge, skills and confidence for academic success and lifelong health.

This progress has been a long time coming and will be extremely beneficial for the 400,000+ kids in the public school system. It will likely influence physical education policies statewide and beyond. The association played a significant role in this advocacy achievement, working alongside our partners in Chicago's public schools and key volunteers who have been involved through this multi-year process. A lot of work remains to be done, but this vote by the Chicago Board of Education is a great victory.